No current system of exercise generates more debate and contention among healthcare professionals (and exercise enthusiasts) than CrossFit. Some wholeheartedly embrace it while others completely disregard it. Either way, a very real problem arises when CrossFit participants sustain injuries, particularly when those injuries require professional attention. This is because: 1) few healthcare professionals actually understand what CrossFit is, 2) few know how to treat CrossFit injuries effectively, and 3) few know what advice to give to CrossFit participants to help them prevent their injuries from returning or to prevent new injuries from arising.
CrossFit involves high intensity interval training combined with heavy weightlifting. CrossFit proponents call this “high intensity power training” (HIPT). In CrossFit, the exercise sessions are called WOD’s (“workouts of the day”) with participants performing certain exercises for a specified period of time or a group of exercises for AMRAP (“as many rounds as possible”) within a timed period. The workouts are designed to push the body to the limit with high repetitions and high effort in relatively short amounts of time. CrossFit proponents claim this style of training is optimal for the body because it focuses on muscle confusion, constantly activating muscles in different situations, so that they never get used to the workouts and are constantly challenged.
CrossFit workouts focus on power, ballistic, and endurance exercises. This can actually include a wide variety of exercises, ranging from running and rowing to Olympic lifting (snatch, clean and jerk, push-press), kettlebell exercises, as well as gymnastic/calisthenic/plyometric movements (such as pull-ups, toes-to-bar, knees-to-elbows, lunges, muscle-ups, burpees, dips, glute–hamstring raises, sit-ups, push-ups, rope climbs, handstand push-ups, and pistols). Exercises from each of these categories are randomly selected and combined with others to create high intensity exercise activities that are performed in rapid, repetitive succession, with limited or no recovery time. CrossFit workouts have been demonstrated to improve strength, fitness, and body composition among those that pursue them seriously.
Injuries do occur with CrossFit, just like any other activity. Fortunately, injuries such as broken bones, dislocations, and concussions are very rare. Instead, most CrossFit injuries involve acute sprains and strains as well as chronic pain associated with repetitive microtrauma (overuse injuries). One study of CrossFit reports a dropout rate of 16% attributed to overuse and injury.
The most commonly injured body parts in CrossFit are the shoulder, low back, and knee. With the gymnastics derived exercises and overhead lifting movements, the shoulder is injured most often. For powerlifting -type movements, it is the lower back that is injured most often.
In one of the better designed scientific studies to date, (many are very flawed), the overall injury rate in CrossFit was found to be approximately 20%. Of those injured, 84% reported one area of injury, 13.3% reported two areas, and 2.7% reported three injuries.
Male athletes tend to injure themselves more frequently in CrossFit than female athletes. Studies seem to suggest that females are more likely to seek help from a trainer and this, many believe, accounts for their decreased injury rate compared to males. However, the differences in in male and female injury rates appear to level out when both perform their CrossFit workouts with instruction and supervision. Therefore, it is clear that the amount and QUALITY of instruction is an important consideration when deciding whether and where to pursue CrossFit.
Common Reasons For CrossFit Injuries
Poor exercise form: Injuries in CrossFit commonly arise from poor, rushed, or haphazardly performed exercises. Unfortunately, in the CrossFit scenario, with workouts and competitions being judged on the basis of how much weight is lifted, for the greatest number of repetitions, within limited periods of time, attention to proper exercise form is often ignored by participants in their urgency to win competitions or set personal records. The risk of injury in any exercise endeavor can exponentially increase when proper exercise form falls by the wayside.
Excessive stress/sudden loading: Standard push-ups, handstand push-ups, push press, push jerk, kipping pull-ups, hang power clean, hang power snatch, ring dips, and overhead squatting are very stressful, especially on the shoulder. These stresses can produce either instant or cumulative injury depending upon the intensity and frequency of the exercises being performed as well as the workout recovery interval. With regard to the shoulder, proper scapular positioning and proper stabilizing strength throughout the rotator cuff and scapula is essential for the shoulder to withstand the stress forces encountered with many of these exercises. Unfortunately, scapular/postural positioning is not often taught to CrossFit participants. Also, often missing from CrossFit are individualized workouts designed to incorporate corrective exercises that target a participant’s unique deficiencies in postural alignment and stabilization strength.
Muscle/Strength/Posture Imbalances: When exposed to weight training, trainees usually discover certain muscles that grow larger and stronger than others in response to their exercise efforts. Moreover, when certain exercises or types of exercises are favored or performed more frequently than others, imbalances in the body’s muscle tone and strength can be created. These imbalances can eventually affect joint mechanics or can actually cause subtle changes in posture (particularly shoulder blade posture/spatial positioning). Very often, these exercise-induced changes can increase injury risk.
Failure to cycle or periodize exercise intensity/frequency: In most individual Olympic sports the training sessions are planned in a manner in which the frequency and intensity of workouts is “periodized” or “cycled.” This allows athletes to safely achieve their physical peak at specified times that coincide with important competitions. Olympic coaches recognize that no human being can perform at max effort on a year-round basis without experiencing injury or burnout.
In contrast, CrossFit trainees are often observed to push their limits every day. Over time, overuse of the shoulder and other joints in the body can lead to injury. If these injuries are not properly attended to prior to performing another CrossFit session these injuries may become chronic. Multiple studies suggest that constantly exercising at high intensity may also provoke general overtraining syndrome – a drop in energy and performance that happens when the body is unable to fully recover from workouts. There has also been emerging evidence of early tendon degeneration associated with high-frequency ballistic or plyometric exercises.
Your Best Choice For CrossFit Injuries
Unlike other healthcare professionals, Dr. Douglas Cancel and Performance Sport-Care will NEVER take “the easy way out” by simply suggesting that injured CrossFit participants abandon CrossFit and try to pass this off as effective treatment. Instead, Dr. Cancel will take the time to accurately identify the cause of injuries, identify mobility issues/strength imbalances, and determine the most effective treatment, rehabilitation and nutritional strategies to resolve or maximally cure them.
Dr. Douglas Cancel and Performance Sport-Care understand that progress can be halted and valuable physical conditioning can be lost by extending training layoffs. Whenever possible, Dr. Cancel will strive to keep CrossFit participants in the game by retraining them on exercise form, prescribing custom rehabilitative exercises, suggesting alternate workouts, and introducing various self treatment strategies.
In terms of passive treatment options, Dr. Douglas Cancel and Performance Sport-Care is a TRUE sports chiropractic and rehabilitative facility offering a full spectrum of modalities which include, but are not limited to, Chiropractic spinal and extremity manipulation, advanced soft tissue therapies such as active/myofascial release, as well as taping, assisted stretching ultrasound and other physio- therapeutic supportive modalities.
In addition to available treatment modalities, Dr. Cancel and Performance Sport-Care will work with you to identify the underlying cause of your problem, even when it is not obvious. We have a commercial rack, along with bars, boxes and bumper plates within our facility so we can not only watch you perform your CrossFit exercises but also conduct a video analysis of your movement patterns to determine how pain may be tied to your exercise performance, mobility issues, and muscle imbalances.
Add it all up and you have a winning team to help CrossFit participants conquer their injuries.